Provider Demographics
NPI:1730534637
Name:LIVING WELL FAMILY MEDICINE PC
Entity type:Organization
Organization Name:LIVING WELL FAMILY MEDICINE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-204-6374
Mailing Address - Street 1:4999 E KENTUCKY AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3901
Mailing Address - Country:US
Mailing Address - Phone:720-770-8199
Mailing Address - Fax:720-770-8399
Practice Address - Street 1:4999 E KENTUCKY AVE STE 103
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3901
Practice Address - Country:US
Practice Address - Phone:720-770-8199
Practice Address - Fax:720-770-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93179065Medicaid
CO93179065Medicaid